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History of the National Health Service

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The name National Health Service (NHS) is used to refer to the four public health services of England, Northern Ireland, Scotland and Wales, individually or collectively, though only England's NHS officially has this title. For details of the history of each National Health Service, see:

The NHS was the first universal health care system established anywhere in the world.[1]

The NHS in Scotland was established as a separate entity with its own legislation, the National Health Service (Scotland) Act 1947, from the foundation of the NHS in 1948. Northern Ireland likewise had its own legislation in 1948. Wales, however, was managed from England and treated much like an English region for the first 20 years of the NHS. In 1969, responsibility for the NHS in Wales was passed to the Secretary of State for Wales from the Secretary of State for Health who was thereafter just responsible for the NHS in England.

In 1948 across England and Wales there were 377 hospital Management Committees, and 36 Teaching Hospitals, each with its own board of governors. There were also 146 Local Health Authorities, running health centres, ambulances services and other community services, and 140 Executive Councils, managing General Practices, NHS dentistry, pharmacists and opticians.[2]

In 1979 across the whole UK there were about 2,750 NHS hospitals with about 480,000 beds, accounting for about 70% of total NHS expenditure. About one-third of beds in England were then provided in new or converted accommodation built since 1948 with a higher proportion in Northern Ireland, but lower in Scotland and Wales. Beds for mental illness, geriatric patients and mental handicap were much more likely to be in older buildings than acute or maternity services.[3]

Cultural History of the NHS

Film and Television

Film and television have played important roles in forming cultural understandings of the National Health Service. Hospitals and GP practices, in particular, have been repeatedly dramatised as locations that lend themselves to displaying wider life stories - love, birth, ageing, dying, friendships and feuds.[4] The NHS has also been an important topic within public health, often forming a central part in public information films about health and wellbeing.[4]

Public Information Films

From the launch of the National Health Service in 1948, film was used as an important cultural tool for spreading governmental health messages. During the Second World War, film grew in popularity as a way for the British government to keep citizens informed, impart advice and help raise morale on the Home Front.[5] This commitment to producing public information films continued after the end of the War in 1945 with the newly formed Central Office of Information taking responsibility for the production of these films. This ensured that the launch of the NHS was accompanied by a number of public information films shown nationwide during Spring and Summer 1948. Three main films were produced - Charley: You're Very Good Health (Halas & Batchelor, 1948)[6], Here's Health (Douglas Alexander, 1948)[7] and Doctor's Dilemma (Unknown, 1948)[8]. These films introduced the NHS in three distinct ways with Charley: You're Very Good Health focused on explaining how the NHS would work upon its launch in a light-hearted manner with Charley standing in as the 'everyman' within the film's narrative. The film used a series of 'suppose' scenarios to outline how the new NHS system would work in practice in comparison to the pre-NHS health care system.[6] Here's Health instead employed the narrative techniques of melodrama to dramatise one family's response to a household accident and the sudden need for medical attention during the Christmas of 1947. It uses flash-forwards to show how these type of care and the cost of it will be altered by the introduction of the NHS.[7] The third main film used to advertise the launch of the NHS was a much briefer, information short, centred on the use of voice-over and a combination of still and moving images to encourage members of the public to register with an NHS GP before the National Health Service Act came into force on the 5th of July 1948.[8]

Film poster for White Corridors (1951) with women hugging a man in a white doctors' coat with a nurse in uniform running on the right-hand side
White Corridors (1951)

Within a few years of the NHS, popular fictional films were beginning to focus on the NHS as a location for dramatic narratives. Films such as White Corridors (Pat Jackson, 1951) and Mandy (Alexander MacKendrick,1952), shown within the early years of the NHS, showed day-to-day life in an NHS hospital as well as dealing with specific single-issue topics such as deafness within postwar British society.[9] The Doctor series, starring firstly Dirk Bogarde and later Leslie Philips, took a comedic look at a the antics of a young doctor in an NHS hospital and the Carry on ... comedies, Carry on Nurse (Gerald Thomas,1959), Carry on Doctor (Gerald Thomas, 1967) and Carry on Matron (Gerald Thomas, 1972) also used comic situations within the NHS hospital to poke fun at both the NHS as an institution and the capers of doctors, nurses and patients alike. From the late 1950s, the NHS also became an important subject within the wider history of British soap operas. Emergency Ward 10 was first broadcast in 1957 on ITV and ran until 1967 and followed the life and loves of the staff and patients of the fictionalised Oxbridge General. ITV later followed this up with General Hospital which borrowed much from Emergency Ward 10 in terms of its themes and focus. The idea of a medical hospital as a suitable and popular setting for a soap opera continued to take root in the 1980s. Casualty, set in an A&E department, was first broadcast in 1986 and has since become the longest running medical drama in the world.[10] At a time when controversy over the NHS was high on the public agenda, Paul Unwin and Jeremy Brock began their proposal for Casualty by declaring that ‘In 1948 a dream was born: a National Health Service. In 1985 the dream is in tatters.’[10] This politicised agenda remained in evidence during the first three series of the Casualty, with the programme showing how those who fictionally worked for the NHS were also dissatisfied with the new direction of the Service.[10] During the 1990s television began more overtly showing medial practitioners who were critical or cynical of the NHS. In particular, Cardiac Arrest was broadcast on BBC 1 utilised this type of cynicism within its narrative plots. Television has also forged a place for the NHS within reality television programming. In particular 24 Hours in A&E and One Born Every Minute have adopted medical documentary formats to show the inner workings of particular NHS hospital departments. Fly-on-the-wall footage is interweaved with interviews with patients, staff and relatives as they give their perspectives on the medical cases shown in each episode.

Comedy

Comedy films, books, and cartoons have been produced about the NHS. These have shaped as well as reflected how people think about this institution.[11]

Cartoons

There have been lots of cartoons about the NHS throughout the institution's history. Even before the NHS was launched, there were cartoons documenting the political debates about its form. In the 1940s, the British Medical Association was opposed to the idea of doctors becoming state employees on fixed salaries.[12] Cartoonists made their opinions about this conflict known. David Low published a cartoon in the Evening Standard on the 14 December 1944 showing Charles Hill, the BMA Secretary, being examined by a doctor. The doctor states, 'Don't be alarmed. Whatever's the trouble, you're not going to die from enlargement of the social conscience.'[13]

When the NHS was launched, many cartoons showed how people responded to the NHS being free at the point of access. One cartoon, published in 1951 by Antonia Yeoman, portrayed women in a doctor's waiting room, one of whom stated that she had seen eighteen doctors and seven psychiatrists. Eventually, she had been diagnosed with a 'deep-seated guilt about getting things free from the National Health Service.'[14] Analysing cartoons about health featured in Punch magazine from 1948, the historian Bernard Zeitlyn argues that they 'centred on the bonanza of free spectacles, beards and trips abroad' that the NHS would bring.[15] Cartoonists also portrayed public excitement about the availability of free wigs on the NHS. In one such example, from January 1949, cartoonist Joseph Lee showed an irate man chasing a child, asking, 'Who's been practising Home Perms on my free National Health Service wig?'[16]

Cartoons were also used to criticise NHS policy. From 1948, Zeitlyn also found cartoons portraying concern about the 'bureaucratic consequences' of the NHS.[17] The number of critical cartoons about NHS policy increased from the 1960s, as the NHS faced cuts, and the satire movement emerged in Britain. In December 1960, cartoonist Victor Weisz drew an image for the Evening Standard showing Minister for Health Enoch Powell as a surgeon covered in blood, accusing him of making too many cuts.[18] Other cartoonists suggested that too much was being spent on the NHS. For example in the Daily Mail in 1968, John Musgrave-Wood drew a man to portray the NHS, who was wearing a dunce's cap and being fed 'Defence Cuts'.[19] Many cartoons have been very interested in portraying NHS staff, both their lives and industrial conflict. The cartoonist Carl Giles, who often drew for the Daily Express, was very interested in drawing nurses in particular. Historian Jack Saunders has argued that Giles' presentation shifted from presenting nurses from 'caring and sexualised' to 'bolshie and assertive'.[20] Giles sent a cartoon of nurses stealing peas from patients directly to the East Suffolk Nurses League. On the cartoon, Giles wrote 'with deepest sympathy', referring to the cutting of food allowances.[21]

Everyday humour

Patients and staff have made jokes about the NHS to one another, on a daily basis, throughout time. However, it is very hard to locate and to understand these.[22] Sometimes 'everyday' jokes about the NHS are mentioned in passing in newspaper coverage. For example, one letter published by the Daily Mail in October 1988 described the experiences of an NHS secretary who 'seethed with anger' when hearing a consultant joke about spending his days on a golf course.[23] The People's History of the NHS project at the University of Warwick has collected more such memories on its website, and invites contributions for more.[24]

Researchers and clinicians hope that humour and laughter may be able to be used to improve human health. The term 'gelotology', to denote the study of laughter, was created in 1964 by Edith Trager and W. F. Fry.[25] One experiment from 2011, led by researchers at the University of Oxford, suggested that watching comedy videos may raise people's pain thresholds, when watched in a group. This effect did not hold when videos were watched alone, or if research participants watched videos such as scenes of nature.[26] In 2003, the artist Nicola Green and film-maker Lara Agnew created a 'laughter booth' at the Royal Brompton Hospital. In this booth, patients and staff could watch videos of people laughing.[27] The idea of laughter as healing has also influenced language, through the phrase 'laughter is the best medicine'.


See also

References

  1. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 3. ISBN 978-1-137-49661-4.
  2. ^ Webster, Charles (1998). The National Health Service A Political History. OUP. p. 21. ISBN 0 19 289296 7. Retrieved 20 May 2015.
  3. ^ Royal Commission on the NHS Chapter 10. HMSO. July 1979. ISBN 0101761503. Retrieved 19 May 2015.
  4. ^ a b Harper, Graeme and Andrew Moor (2005). Signs of Life: Cinema and Medicine. London: Wallflower Press. ISBN 1904764169.
  5. ^ Farmer, Richard (2011). The Food Companions: Cinema and consumption in wartime Britain, 1939-1945. Manchester: Manchester University Press. ISBN 9780719083136.
  6. ^ a b Archives, The National. "Public Information Films | 1945 to 1951 | Your Very Good Health". www.nationalarchives.gov.uk. Retrieved 2016-11-22.
  7. ^ a b "Here's Health (1948)". BFI. Retrieved 2016-11-22.
  8. ^ a b "Doctor's Dilemma (1948)". BFI. Retrieved 2016-11-22.
  9. ^ Cartwright, Lisa (2007). 'Mandy (1952): On Voice and Listening in the (Deaf) Maternal Melodrama' in Medicine's Moving Pictures: Medicine, Health, and Bodies in American Film and Television. Rochester: University of Rochester Press. pp. 133–162. ISBN 13: 978-1580463065. {{cite book}}: Check |isbn= value: invalid character (help)
  10. ^ a b c Holland, Patricia (2013). Broadcasting and the NHS in the Thatcherite 1980s: The Challenge to Public Service. London: Routledge. p. 169. ISBN 9780230282377.
  11. ^ Crane, Jenny (10 November 2016). "'Humour and the NHS: Is 'laughter the best medicine'? Is NHS policy a 'sick joke'?". peopleshistorynhs.org. Retrieved 22 November 2016.
  12. ^ "British Medical Association". People's History of the NHS. Retrieved 2016-11-22.
  13. ^ Low, David (14 December 1944). British Cartoon Archive http://archives.cartoons.ac.uk/GetMultimedia.ashx?db=Catalog&type=default&fname=LSE1173.jpg. Retrieved 22 November 2016. {{cite web}}: Missing or empty |title= (help)
  14. ^ "Punch Cartoons by Anton | PUNCH Magazine Cartoon Archive". punch.photoshelter.com. Retrieved 2016-11-22.
  15. ^ Zeitlyn, Bernard (1972). "'Jokes and the Doctor-Patient Relationship'". History of Medicine. 4: 10–12.
  16. ^ Lee, Joseph (11 January 1949). "London Laughs: Free NHS Wig". British Cartoon Archive. Retrieved 22 November 2016.
  17. ^ Zeitlyn, Bernard (1972). "'Jokes and the Doctor-Patient Relationship'". History of Medicine. 4: 10–12.
  18. ^ Weisz, Victor (5 December 1960). "National Health Service: Operating Theatre".
  19. ^ Musgrave-Wood, John (9 January 1968). "The Hypochondriac". British Cartoon Archive. Retrieved 22 November 1968. {{cite web}}: Check date values in: |access-date= (help)
  20. ^ "Nurses' Christmas, 1963". People's History of the NHS. Retrieved 2016-11-22.
  21. ^ "Pinching Peas, 1969". People's History of the NHS. Retrieved 2016-11-22.
  22. ^ "Humour and the NHS: Is 'laughter the best medicine'? Is NHS policy a 'sick joke'?". People's History of the NHS. Retrieved 2016-11-22.
  23. ^ Anonymous (4 October 1988). "A sick way to treat a patient". Daily Mail: 34.{{cite journal}}: CS1 maint: year (link)
  24. ^ [peopleshistorynhs.org "People's History of the NHS"]. {{cite web}}: Check |url= value (help)
  25. ^ Butler, Barbara (2005). "Laughter: The Best Medicine?" (PDF). Oregon Library Association. 11.
  26. ^ Dunbar, R. I. M.; Baron, Rebecca; Frangou, Anna; Pearce, Eiluned; Leeuwin, Edwin J. C. van; Stow, Julie; Partridge, Giselle; MacDonald, Ian; Barra, Vincent (2011-09-14). "Social laughter is correlated with an elevated pain threshold". Proceedings of the Royal Society of London B: Biological Sciences: rspb20111373. doi:10.1098/rspb.2011.1373. ISSN 0962-8452. PMC 3267132. PMID 21920973.
  27. ^ "BBC NEWS | Health | NHS stories: The laughter tonic". news.bbc.co.uk. Retrieved 2016-11-22.
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